1
|
Altes A, Vermes E, Levy F, Vancraeynest D, Pasquet A, Vincentelli A, Gerber BL, Tribouilloy C, Maréchaux S. Quantification of primary mitral regurgitation by echocardiography: A practical appraisal. Front Cardiovasc Med 2023; 10:1107724. [PMID: 36970355 PMCID: PMC10036770 DOI: 10.3389/fcvm.2023.1107724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
Collapse
Affiliation(s)
- Alexandre Altes
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Correspondence: Sylvestre Maréchaux
| |
Collapse
|
2
|
Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
Collapse
Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| |
Collapse
|
3
|
Zhang B, Wang H, Meng Q, Tao J, Lu H, Wu W, Zhu Z, Wang H. Quantification of chronic aortic regurgitation using left and right ventricular stroke volumes obtained from two new automated three-dimensional transthoracic echocardiographic software: feasibility and accuracy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:789-799. [PMID: 34800186 DOI: 10.1007/s10554-021-02471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The present study aimed to evaluate the feasibility and accuracy of chronic aortic regurgitation (CAR) quantification using left and right ventricular stroke volumes (LVSV and RVSV, respectively) obtained from two new automated three-dimensional transthoracic echocardiographic software-Dynamic HeartModel (DHM) and 3D Auto RV. Patients (n=116) with more than mild isolated CAR were included and divided into two groups: central (n=53) and eccentric CAR (n=63) groups. LVSV and RVSV were automatically measured by DHM and 3D Auto RV. Next, aortic regurgitant volume (ARVol) was calculated three ways: as the difference between LVSV and RVSV, by the two-dimensional proximal isovelocity surface area (PISA) method, and using effective regurgitant orifice area derived from real-time three-dimensional echocardiography (RT3DE) multiplied by CAR velocity time integral (the reference standard). DHM plus 3D Auto RV correlated well with RT3DE in ARVol measurement in both groups (central, r = 0.90; eccentric, r = 0.96), with no significant difference based on consistency analysis. In the eccentric group, PISA led to an obvious underestimation (mean difference= - 4.20 ml, P < 0.05). The kappa agreement between DHM plus 3D Auto RV and RT3DE in grading CAR severity in both groups was good (central, k = 0.89; eccentric, k = 0.86), but that between PISA and RT3DE in the eccentric CAR group was suboptimal (k = 0.74). This study indicates that ARVol quantification using DHM plus 3D Auto RV is feasible and reproducible in patients with more than mild isolated CAR. This new method has great correlation and agreement with RT3DE in ARVol measurement, with evident advantages over PISA in eccentric CAR.
Collapse
Affiliation(s)
- Bing Zhang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Han Wang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qinglong Meng
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jia Tao
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongquan Lu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhenhui Zhu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| |
Collapse
|
4
|
Automatic Assessment of Mitral Regurgitation Severity Using the Mask R-CNN Algorithm with Color Doppler Echocardiography Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2602688. [PMID: 34552659 PMCID: PMC8452404 DOI: 10.1155/2021/2602688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Accurate assessment of mitral regurgitation (MR) severity is critical in clinical diagnosis and treatment. No single echocardiographic method has been recommended for MR quantification thus far. We sought to define the feasibility and accuracy of the mask regions with a convolutional neural network (Mask R-CNN) algorithm in the automatic qualitative evaluation of MR using color Doppler echocardiography images. The authors collected 1132 cases of MR from hospital A and 295 cases of MR from hospital B and divided them into the following four types according to the 2017 American Society of Echocardiography (ASE) guidelines: grade I (mild), grade II (moderate), grade III (moderate), and grade IV (severe). Both grade II and grade III are moderate. After image marking with the LabelMe software, a method using the Mask R-CNN algorithm based on deep learning (DL) was used to evaluate MR severity. We used the data from hospital A to build the artificial intelligence (AI) model and conduct internal verification, and we used the data from hospital B for external verification. According to severity, the accuracy of classification was 0.90, 0.89, and 0.91 for mild, moderate, and severe MR, respectively. The Macro F1 and Micro F1 coefficients were 0.91 and 0.92, respectively. According to grading, the accuracy of classification was 0.90, 0.87, 0.81, and 0.91 for grade I, grade II, grade III, and grade IV, respectively. The Macro F1 and Micro F1 coefficients were 0.89 and 0.89, respectively. Automatic assessment of MR severity is feasible with the Mask R-CNN algorithm and color Doppler electrocardiography images collected in accordance with the 2017 ASE guidelines, and the model demonstrates reasonable performance and provides reliable qualitative results for MR severity.
Collapse
|
5
|
Cormican DS, Drennen Z, Sonny A, Crowley JC, Gil IJN, Ramakrishna H. Functional Mitral Regurgitation in Heart Failure: Analysis of the ESC Multidisciplinary Heart-Team Position Statement and Review of Current Guidelines. J Cardiothorac Vasc Anesth 2021; 36:3357-3364. [PMID: 34607763 DOI: 10.1053/j.jvca.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Zachary Drennen
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jerome C Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Iván J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
6
|
Coats AJS, Anker SD, Baumbach A, Alfieri O, von Bardeleben RS, Bauersachs J, Bax JJ, Boveda S, Čelutkienė J, Cleland JG, Dagres N, Deneke T, Farmakis D, Filippatos G, Hausleiter J, Hindricks G, Jankowska EA, Lainscak M, Leclercq C, Lund LH, McDonagh T, Mehra MR, Metra M, Mewton N, Mueller C, Mullens W, Muneretto C, Obadia JF, Ponikowski P, Praz F, Rudolph V, Ruschitzka F, Vahanian A, Windecker S, Zamorano JL, Edvardsen T, Heidbuchel H, Seferovic PM, Prendergast B. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J 2021; 42:1254-1269. [PMID: 33734354 PMCID: PMC8014526 DOI: 10.1093/eurheartj/ehab086] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology-the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)-presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.
Collapse
Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology (CVK), Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany.,Charité Universitätsmedizin Berlin, Germany
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Yale University School of Medicine, New Haven, USA
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania
| | - John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christoph Leclercq
- Université de Rennes I, CICIT 804, Rennes, CHU Pontchaillou, France, Rennes
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mandeep R Mehra
- Brigham Women's Hospital Heart and Vascular Center and the Center of Advanced Heart Disease, Harvard Medical School, Boston, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel, Centre d'Investigation Clinique, Filière Insuffisance Cardiaqu, e, France, Lyon
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Frank Ruschitzka
- Cardiology Clinic, University Heart Center, University Hospital Zürich, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.,University Alcala, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | | | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
| |
Collapse
|
7
|
The mitral regurgitation effects of cardiac structure and function in left ventricular noncompaction. Sci Rep 2021; 11:4616. [PMID: 33633309 PMCID: PMC7907249 DOI: 10.1038/s41598-021-84233-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
This study evaluated the effects of mitral regurgitation (MR) on cardiac structure and function in left ventricular noncompaction (LVNC) patients. The clinical and cardiovascular magnetic resonance (CMR) data for 182 patients with noncompaction or hypertrabeculation from three institutes were retrospectively included. We analyzed the difference in left ventricular geometry, cardiac function between LVNC patients with and without MR. The results showed that patients with MR had a worse New York Heart Association (NYHA) class and a higher incidence of arrhythmia (P < 0.05). MR occurred in 48.2% of LVNC patients. Compared to LVNC patients without MR, the two-dimensional sphericity index, maximum/minimum end-diastolic ratio and longitudinal shortening in LVNC patients with MR were lower (P < 0.05), and the peak longitudinal strain (PLS) of the global and segmental myocardium were obviously reduced (P < 0.05). No significant difference was found in strain in LVNC patients with different degree of MR; end diastolic volume, end systolic volume, and global PLS were statistically associated with MR and NYHA class (P < 0.05), but the non-compacted to compacted myocardium ratio had no significant correlation with them. In conclusion, the presence of MR is common in LVNC patients. LVNC patients with MR feature more severe morphological and functional changes. Hypertrabeculation is not an important factor affecting structure and function at the heart failure stage.
Collapse
|
8
|
Gajjar K, Kashyap K, Badlani J, Williams RB, Biederman RWW. A review of the pivotal role of cardiac MRI in mitral valve regurgitation. Echocardiography 2020; 38:128-141. [PMID: 33270944 DOI: 10.1111/echo.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
Cardiac imaging is the cornerstone of defining the etiology, quantification, and management of mitral regurgitation (MR). This continues to be even more so the case with emerging transcatheter techniques to manage MR. Transthoracic echocardiography remains the first-line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative nonvisual estimation, 3D volumetric data, late gadolinium, T1, and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling, and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.
Collapse
Affiliation(s)
- Kushani Gajjar
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Kartikeya Kashyap
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Jayshiv Badlani
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Ronald B Williams
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert W W Biederman
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Drexel University, Philadelphia, PA, USA.,Bioengineering Department, Carnegie Mellon University, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Hagendorff A, Knebel F, Helfen A, Stöbe S, Doenst T, Falk V. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging 2020; 37:183-196. [PMID: 32851501 PMCID: PMC7878255 DOI: 10.1007/s10554-020-01975-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
The contradictory findings of recent prospective randomized controlled trials assessing the impact of percutaneous edge-to-edge repair in patients with functional or secondary mitral regurgitation have triggered a lively discussion about an “integrated” echocardiographic approach for grading severity of mitral regurgitation. In the MITRA-FR trial, the COAPT trial and the REDUCE-FMR trial echocardiographic assessment of the severity of mitral regurgitation was consistent with principles set forth by the current echocardiographic guidelines and analysed in its best settings by expert international leaders in the field of echocardiography. However, serious inconsistencies appeared in the presented echocardiographic assessments regarding cardiac output and regurgitant fraction. A new term “disproportionate functional mitral regurgitation” was introduced describing a situation where the increase of effective regurgitant orifice area exceeds the enlargement of the left ventricular end-diastolic volumes. Further discussion resulted in the idea of a “new conceptional framework” for distinguishing “proportionate” and “disproportionate” functional mitral regurgitation. The aim of this viewpoint is to dispute conclusions based on the term “disproportionate” mitral regurgitation. A “disproportionate” FMR is highly questionable because disproportionateness of flow in communication vessels cannot exist. In addition, a proposal of echocardiographic assessment based on a conventional comprehensive transthoracic echocardiography is given to avoid obvious hemodynamic contradictions.
Collapse
Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Leipzig, Germany.
- Department of Cardiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Andreas Helfen
- Department of Cardiology, St. Marien Hospital Lünen, Lünen, Germany
- Co-Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Stephan Stöbe
- Department of Cardiology, University of Leipzig, Leipzig, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| |
Collapse
|
10
|
Ali M, Shreenivas SS, Pratt DN, Lynch DR, Kereiakes DJ. Percutaneous Interventions for Secondary Mitral Regurgitation. Circ Cardiovasc Interv 2020; 13:e008998. [PMID: 32757659 DOI: 10.1161/circinterventions.120.008998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mitral regurgitation is frequently associated with ventricular dysfunction and carries a high mortality. Guideline-directed medical therapy, surgical mitral valve repair or replacement, and, in the setting of advanced heart failure, heart transplant and left ventricular assist devices have been the mainstay of treatment. However, rapid advancement in the field has resulted in approval of edge-to-edge mitral valve repair with the MitraClip, and there are several novel catheter-based percutaneous options in clinical trials. Percutaneous options, while promising, must be deployed in patients who are most likely to benefit, and thus, understanding the pathophysiology of specific subgroups of patients with functional mitral regurgitation (eg, disproportionate versus proportionate mitral regurgitation) is key to the success of new devices. We review the pathophysiology, percutaneous therapeutic treatment options, and ongoing clinical trials for functional mitral regurgitation.
Collapse
Affiliation(s)
- Mahboob Ali
- University of Cincinnati, OH (M.A., D.N.P., D.R.L.)
| | | | | | | | | |
Collapse
|
11
|
Long Q, Ye X, Zhao Q. Artificial intelligence and automation in valvular heart diseases. Cardiol J 2020; 27:404-420. [PMID: 32567669 DOI: 10.5603/cj.a2020.0087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Abstract
Artificial intelligence (AI) is gradually changing every aspect of social life, and healthcare is no exception. The clinical procedures that were supposed to, and could previously only be handled by human experts can now be carried out by machines in a more accurate and efficient way. The coming era of big data and the advent of supercomputers provides great opportunities to the development of AI technology for the enhancement of diagnosis and clinical decision-making. This review provides an introduction to AI and highlights its applications in the clinical flow of diagnosing and treating valvular heart diseases (VHDs). More specifically, this review first introduces some key concepts and subareas in AI. Secondly, it discusses the application of AI in heart sound auscultation and medical image analysis for assistance in diagnosing VHDs. Thirdly, it introduces using AI algorithms to identify risk factors and predict mortality of cardiac surgery. This review also describes the state-of-the-art autonomous surgical robots and their roles in cardiac surgery and intervention.
Collapse
Affiliation(s)
- Qiang Long
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China.
| | - Xiaofeng Ye
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China
| | - Qiang Zhao
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China
| |
Collapse
|
12
|
Jacobs K, Rigdon J, Chan F, Cheng JY, Alley MT, Vasanawala S, Maskatia SA. Direct measurement of atrioventricular valve regurgitant jets using 4D flow cardiovascular magnetic resonance is accurate and reliable for children with congenital heart disease: a retrospective cohort study. J Cardiovasc Magn Reson 2020; 22:33. [PMID: 32404159 PMCID: PMC7222506 DOI: 10.1186/s12968-020-00612-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method. METHODS We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5 T or 3 T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard) = stroke volume by 2D balanced steady-state free precession - semilunar valve forward flow (SLFF); annular inflow method (AIM) = atrioventricular valve forward flow [AVFF] - semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]× 100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired t-test, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate. RESULTS Regurgitant fraction by JET strongly correlated with the indirect methods (VOL and AIM) (ρ = 0.73-0.80, p < 0.001) and was similar to VOL with a median difference (interquartile range) of - 1.5% (- 8.3-7.2%; p = 0.624). VOL had weaker correlations with AIM and JET (ρ = 0.69-0.73, p < 0.001). AIM underestimated RF by 3.6-6.9% compared to VOL and JET, p < 0.03. Intra- and inter- observer reliability were excellent for all methods (ICC 0.94-0.99). The mean (±standard deviation) inter-observer difference for VOL was 2.4% (±5.1%), p < 0.05. CONCLUSIONS In a diverse cohort of pediatric CHD, measurement of AVVR using JET is accurate and reliable to VOL and is a superior method of internal validation compared to AIM. This study supports use of 4DF CMR for measurement of AVVR, obviating need for expert prospective prescription during image acquisition by 2D CMR.
Collapse
Affiliation(s)
- Kimberley Jacobs
- Department of Pediatrics, Stanford University School of Medicine, 725 Welch Rd, Room G71, MC 5906, Palo Alto, CA, 94304, USA.
| | - Joseph Rigdon
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Frandics Chan
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Joseph Y Cheng
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Marcus T Alley
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shreyas Vasanawala
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shiraz A Maskatia
- Department of Pediatrics, Divisions of Pediatric Cardiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| |
Collapse
|
13
|
Abstract
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
Collapse
|
14
|
Blanken CPS, Farag ES, Boekholdt SM, Leiner T, Kluin J, Nederveen AJ, van Ooij P, Planken RN. Advanced cardiac MRI techniques for evaluation of left-sided valvular heart disease. J Magn Reson Imaging 2019; 48:318-329. [PMID: 30134000 PMCID: PMC6667896 DOI: 10.1002/jmri.26204] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/19/2018] [Indexed: 01/06/2023] Open
Abstract
The most common types of left‐sided valvular heart disease (VHD) in the Western world are aortic valve stenosis, aortic valve regurgitation, and mitral valve regurgitation. Comprehensive clinical evaluation entails both hemodynamic analysis and structural as well as functional characterization of the left ventricle. Cardiac magnetic resonance imaging (MRI) is an established diagnostic modality for assessment of left‐sided VHD and is progressively gaining ground in modern‐day clinical practice. Detailed flow visualization and quantification of flow‐related biomarkers in VHD can be obtained using 4D flow MRI, an imaging technique capable of measuring blood flow in three orthogonal directions over time. In addition, recent MRI sequences enable myocardial tissue characterization and strain analysis. In this review we discuss the emerging potential of state‐of‐the‐art MRI including 4D flow MRI, tissue mapping, and strain quantification for the diagnosis and prognosis of left‐sided VHD. Level of Evidence: 1 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2018. J. MAGN. RESON. IMAGING 2018;48:318–329.
Collapse
Affiliation(s)
- Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Emile S Farag
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Tim Leiner
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Hagendorff A, Doenst T, Falk V. Echocardiographic assessment of functional mitral regurgitation: opening Pandora's box? ESC Heart Fail 2019; 6:678-685. [PMID: 31347297 PMCID: PMC6676284 DOI: 10.1002/ehf2.12491] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 12/26/2022] Open
Abstract
Two recent trials of transcatheter mitral-valve repair in patients with functional mitral regurgitation (FMR) presented opposing results for the MitraClip® compared to medical therapy alone. The conflicting results gave rise to intensive discussions about assessment of mitral valve regurgitation (MR). A recent editorial viewpoint provided a potential explanation presenting a new pathophysiologic concept. However, the echocardiographic characterization of both trials' patients is inconsistent and the discussed concepts appear to suffer from plausibility weaknesses. It is well conceivable that limitations in the echocardiographic assessment of the trial patients introduced a bias regarding the selection of patients with severe (or less severe) MR that may be a more plausible explanation for the differences in outcome. We here illustrate our viewpoint regarding the two MitraClip trials and also illustrate the difficulties in assessing functional MR properly. It may indeed be "opening Pandora's box", but we will also make an attempt to provide a solution.
Collapse
Affiliation(s)
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Volkmar Falk
- Department of Cardiac Surgery, German Heart Center, Berlin, Germany
| |
Collapse
|
16
|
Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
17
|
Go YY, Dulgheru R, Lancellotti P. The Conundrum of Tricuspid Regurgitation Grading. Front Cardiovasc Med 2018; 5:164. [PMID: 30474032 PMCID: PMC6237828 DOI: 10.3389/fcvm.2018.00164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of "severe." There has been a recent call to expand the TR grading system, encompassing two more grades, namely "massive" and "torrential" TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm2, regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of "massive" is defined by EROA 60-79 mm2, R Vol 60-74 ml and VC 14-20 mm, while "torrential" is defined by EROA ≥80 mm2, R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect.
Collapse
Affiliation(s)
- Yun Yun Go
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
| | - Raluca Dulgheru
- Department of Cardiology, University Hospital Sart Tilman, Heart Valve Clinic, University of Liège, Liège, Belgium.,GIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University Hospital Sart Tilman, Heart Valve Clinic, University of Liège, Liège, Belgium.,GIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| |
Collapse
|
18
|
Alkhouly AA, Al-Amin AM, Mukarrab MI. Role of three dimensional transesophageal echocardiography in predicting mitral regurgitation after percutaneous balloon mitral valvuloplasty. Indian Heart J 2018; 70:836-842. [PMID: 30580853 PMCID: PMC6306348 DOI: 10.1016/j.ihj.2018.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/27/2017] [Accepted: 01/20/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Percutaneous balloon mitral valvuloplasty (PBMV) can be complicated with significant mitral regurgitation (MR). We performed a pilot, prospective study to evaluate the role of three dimensional transesophageal echocardiography (3D-TEE) in the prediction of MR after PBMV through mitral valve quantification (MVQ). METHODS Between October 2014 and October 2016, 37 patients with rheumatic, moderate-to-severe mitral stenosis, referred to the Cath lab of Bab Alshearia University hospitals for PBMV, were divided into two age and sex matched groups. Group I included 25 patients without significant MR following PBMV [vena contract area (VCA) <0.4cm2], while group II included 12 patients with significant MR after PBMV [VCA ≥0.4cm2]. Both groups were comparable in terms of TEE data, Wilkins score for favorability of PBMV and baseline hemodynamics. RESULTS Data from MVQ showed that both groups were comparable (p>0.05) in terms of MV annulus quantification (Anteroposterior diameter, annular sphericity, 3D area and height), MV scallops (A1, A2, A3, P1, P2 and P3) areas, as well as A1 and A2 tenting volumes. However, we recorded significant differences between the two groups as regard total MV, A2, P2 and P3 tenting volumes (p<0.05) and tenting height (p=0.03), as well as A2, A3 and P2 prolapse volumes (p<0.05). Moreover, our data showed a significant difference between both groups in terms of MV coaptation heights (p=0.01), but not in anterior coaptation length (p=0.13). CONCLUSION Mitral valve quantification through 3D-TEE is a simple automated method, easily applicable to patients before PBMV. Moreover, MVQ-derived data, such as MV scallops' tenting and prolapse volumes, coaptation heights, and exposed and total A2 lengths may predict the possibility of significant MR after PBMV.
Collapse
Affiliation(s)
| | - Ali Mohammad Al-Amin
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | |
Collapse
|
19
|
Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions. Radiology 2018; 288:638-655. [DOI: 10.1148/radiol.2018172758] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Weir-McCall
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Philipp Blanke
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Christopher Naoum
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Victoria Delgado
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jeroen J. Bax
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jonathon Leipsic
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| |
Collapse
|
20
|
A Comparative Assessment of Echocardiographic Parameters for Determining Primary Mitral Regurgitation Severity Using Magnetic Resonance Imaging as a Reference Standard. J Am Soc Echocardiogr 2018; 31:992-999. [PMID: 29921479 DOI: 10.1016/j.echo.2018.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The American Society of Echocardiography (ASE) guidelines suggest the use of several echocardiographic methods to assess mitral regurgitation severity using an integrated approach, without guidance as to the weighting of each parameter. The purpose of this multicenter prospective study was to evaluate the recommended echocardiographic parameters against a reference modality and develop and validate a weighting for each echocardiographic measure of mitral regurgitation severity. METHODS This study included 112 patients who underwent evaluation with echocardiography and magnetic resonance imaging (MRI). Echocardiographic parameters recommended by the ASE were included and compared with MRI-derived regurgitant volume (MRI-RV). RESULTS Echocardiographic parameters that correlated best with MRI-RV were proximal isovelocity surface area (PISA) radius (r = 0.65, P < .0001), PISA-derived effective regurgitant orifice area (r = 0.65, P < .0001), left ventricular end-diastolic volume (r = 0.56, P < .0001), and PISA-derived regurgitant volume (r = 0.52, P < .0001). In the linear regression models PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet independently predicted MRI-RV. CONCLUSION Echocardiographic parameters of mitral regurgitation as recommended by the ASE had moderate correlations with MRI-RV. The best predictors of MRI-RV were PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet, suggesting that these parameters should be weighted more heavily than other echocardiographic parameters in the application of the ASE-recommended integrated approach.
Collapse
|
21
|
Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
Collapse
Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| |
Collapse
|
22
|
Argulian E, Seetharam K. Echocardiographic 3D-guided 2D planimetry in quantifying left-sided valvular heart disease. Echocardiography 2018; 35:695-706. [PMID: 29420834 DOI: 10.1111/echo.13828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Echocardiographic 3D-guided 2D planimetry can improve the accuracy of valvular disease assessment. Acquisition of 3D pyramidal dataset allows subsequent multiplanar reconstruction with accurate orthogonal plane alignment to obtain the correct borders of an anatomic orifice or flow area. Studies examining the 3D-guided 2D planimetry approach in left-sided valvular heart disease were identified and reviewed. The strongest evidence exists for estimating mitral valve area in patients with rheumatic mitral valve stenosis and vena contracta area in patients with mitral regurgitation (both primary and secondary). 3D-guided approach showed excellent feasibility and reproducibility in most studies, as well as time efficiency and good correlation with reference and comparator methods. Therefore, 3D-guided 2D planimetry can be used as an important clinical tool in quantifying left-sided valvular heart disease, especially mitral valve disorders.
Collapse
|
23
|
Jansen R, Hart EA, Peters M, Urgel K, Kluin J, Tietge WJ, Zwart K, Sybrandy KC, Cramer MJM, Chamuleau SAJ. An easy-to-use scoring index to determine severity of mitral regurgitation by 2D echocardiography in clinical practice. Echocardiography 2017; 34:1275-1283. [PMID: 28833463 DOI: 10.1111/echo.13636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Mitral regurgitation (MR) grading by two-dimensional transthoracic echocardiography is challenging, but important to determine the best treatment strategy in patients with MR. Current guidelines advocate an integrative approach, although no recommendation is provided on how to do so. An easy-to-use index will be helpful for standardized and reproducible MR grading. METHODS Eleven echocardiographic parameters were retrospectively evaluated in 145 patients with moderate or severe MR. Parameters were scored positive or negative for severe MR, where expert panel consensus reading was considered as the reference standard. Logistic regression was performed, and adjusted coefficients were used to create a risk score for severe MR per patient (ROSE-index). The best cutoff with corresponding predictive values was determined. RESULTS Eighty-two percent of all parameters could be determined. Multivariable analysis revealed five parameters that remained significant predictors for severe MR: morphology, jet characteristics, vena contracta, systolic reversal, and left ventricular dimensions. With different weighing, a total score of 8 could be obtained. Median total ROSE-index score for moderate (2.0) and severe MR (5.0) did significantly differ. The cutoff score (≥4) revealed sensitivity 0.84 and specificity 0.83 to diagnose severe MR. Negative predictive value was 100% for score 0 and 1; score 6-8 showed a 100% positive predictive value. Inter- and intra-observer agreements were excellent (K-values >0.80). CONCLUSION Here, we propose an easy-to-use tool for integrated analysis of guideline parameters to assess MR severity. Using this so-called ROSE-index revealed reliable and reproducible assessment of severe MR (cutoff≥4) that may be helpful for clinical decision making.
Collapse
Affiliation(s)
- Rosemarijn Jansen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Einar A Hart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Urgel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Tietge
- Department of Cardiology, Diaconessenhuis Hospital Leiden, Leiden, The Netherlands
| | - Koen Zwart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten C Sybrandy
- Department of Cardiology, St. Jansdal Hospital Harderwijk, Harderwijk, The Netherlands
| | - Maarten J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW The purpose of this review was to elucidate the additional value of 3D echocardiography for the assessment of mitral regurgitation (MR) compared to standard 2D echocardiography. RECENT FINDINGS 3D echocardiography provides key information, aetiology, degenerative mitral valve disease vs. secondary MR, causes and mechanism, severity by measurements of effective regurgitant orifice area and regurgitant volume; likelihood of reparability and assessment of pre- and intra-mitral valve transcatheter procedures. 3D echocardiography as a promising method for assessment of MR is useful and crucial for research, clinical practice and patient management in all heart valve team members.
Collapse
|
25
|
Sotaquirá M, Pepi M, Tamborini G, Caiani EG. Anatomical Regurgitant Orifice Detection and Quantification from 3-D Echocardiographic Images. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1048-1057. [PMID: 28216111 DOI: 10.1016/j.ultrasmedbio.2016.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/09/2016] [Accepted: 12/24/2016] [Indexed: 06/06/2023]
Abstract
The vena contracta and effective regurgitant orifice area (EROA) are currently used for the clinical assessment of mitral regurgitation (MR) from 2-D color Doppler imaging. In addition to being highly user dependent and having low repeatability, these methods do not represent accurately the anatomic regurgitant orifice (ARO), which affects the adequate assessment of MR patients. We propose a novel method for semi-automatic detection and quantitative assessment of the 3-D ARO shape from 3-D transesophageal echocardiographic images. The algorithm was tested on a set of 25 patients with MR, and compared with EROA for validation. Results indicate the robustness of the proposed approach, with low variability in relation to different settings of user-defined segmentation parameters. Although EROA and ARO exhibited a good correlation (r = 0.8), relatively large biases were measured, indicating that EROA probably underestimates the real shape and size of the regurgitant orifice. Along with the higher reproducibility of the proposed approach, this highlights the limitations of current clinical approaches and underlines the importance of accurate assessment of the ARO shape for diagnosis and treatment in MR patients.
Collapse
Affiliation(s)
- Miguel Sotaquirá
- Faculty of Engineering, Universidad de San Buenaventura Bogotá, Bogotá, Colombia; Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Enrico G Caiani
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| |
Collapse
|
26
|
Kron IL, LaPar DJ, Acker MA, Adams DH, Ailawadi G, Bolling SF, Hung JW, Lim DS, Mack MJ, O'Gara PT, Parides MK, Puskas JD. 2016 update to The American Association for Thoracic Surgery (AATS) consensus guidelines: Ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg 2017; 153:e97-e114. [DOI: 10.1016/j.jtcvs.2017.01.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 01/06/2023]
|
27
|
Heo R, Son JW, ó Hartaigh B, Chang HJ, Kim YJ, Datta S, Cho IJ, Shim CY, Hong GR, Ha JW, Chung N. Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic Echocardiography in Quantifying Mitral Regurgitation: A Comparison with Conventional Two-Dimensional Methods. J Am Soc Echocardiogr 2017; 30:393-403.e7. [DOI: 10.1016/j.echo.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 10/20/2022]
|
28
|
Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
Collapse
Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| |
Collapse
|
29
|
Maslow A, Szymanski T, Mahmood F. Three-Dimensional Echocardiographic Assessment of a Paravalvular Leak. J Cardiothorac Vasc Anesth 2016; 31:1308-1311. [PMID: 27939193 DOI: 10.1053/j.jvca.2016.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Needham, MA.
| | - Trevor Szymanski
- Department of Anesthesiology, Rhode Island Hospital, Needham, MA
| | - Feroze Mahmood
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
30
|
El Haddad M, De Backer T, De Buyzere M, Devos D, Swillens A, Segers P, Timmermans F. Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal. Heart 2016; 103:190-197. [DOI: 10.1136/heartjnl-2016-309510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/24/2022] Open
|
31
|
Omar AMS, Bansal M, Sengupta PP. Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction. Circ Res 2016; 119:357-74. [DOI: 10.1161/circresaha.116.309128] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
Abstract
Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. The present review summarizes the recent advances in the field of echocardiography, with emphasis on their role in HF phenotyping, risk stratification, and optimizing clinical outcomes.
Collapse
Affiliation(s)
- Alaa Mabrouk Salem Omar
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York (A.M.S.O., M.B., P.P.S.); and Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt (A.M.S.O.)
| | - Manish Bansal
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York (A.M.S.O., M.B., P.P.S.); and Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt (A.M.S.O.)
| | - Partho P. Sengupta
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York (A.M.S.O., M.B., P.P.S.); and Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt (A.M.S.O.)
| |
Collapse
|
32
|
Moghaddasi H, Nourian S. Automatic assessment of mitral regurgitation severity based on extensive textural features on 2D echocardiography videos. Comput Biol Med 2016; 73:47-55. [DOI: 10.1016/j.compbiomed.2016.03.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
|
33
|
Kron IL, Acker MA, Adams DH, Ailawadi G, Bolling SF, Hung JW, Lim DS, LaPar DJ, Mack MJ, O'Gara PT, Parides MK, Puskas JD. 2015 The American Association for Thoracic Surgery Consensus Guidelines: Ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg 2016; 151:940-56. [DOI: 10.1016/j.jtcvs.2015.08.127] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/03/2015] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
|
34
|
Boudoulas KD, Pitsis AA, Boudoulas H. Floppy Mitral Valve (FMV) – Mitral Valve Prolapse (MVP) – Mitral Valvular Regurgitation and FMV/MVP Syndrome. Hellenic J Cardiol 2016; 57:73-85. [DOI: 10.1016/j.hjc.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022] Open
|
35
|
Cavalcante JL, Lalude OO, Schoenhagen P, Lerakis S. Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions. JACC Cardiovasc Interv 2016; 9:399-425. [DOI: 10.1016/j.jcin.2015.11.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
|
36
|
Rehfeldt KH, Lambert AS. Assessment of Mitral Regurgitation. Anesth Analg 2016; 122:299-301. [DOI: 10.1213/ane.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Wang A, Grayburn P, Foster JA, McCulloch ML, Badhwar V, Gammie JS, Costa SP, Benitez RM, Rinaldi MJ, Thourani VH, Martin RP. Practice gaps in the care of mitral valve regurgitation: Insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel. Am Heart J 2016; 172:70-9. [PMID: 26856218 DOI: 10.1016/j.ahj.2015.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation. METHODS The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR. A key project element was a set of surveys distributed to primary care and cardiovascular physicians (cardiologists and cardiothoracic surgeons). Survey and other gap analysis findings were presented to a panel of 10 expert advisors from specialties of general cardiology, cardiac imaging, interventional cardiology, and cardiac surgeons with expertise in valvular heart disease, especially MR, and cardiovascular education. The panel was charged with assessing the relative importance and potential means of remedying identified gaps to improve care for patients with MR. RESULTS The survey results identified several knowledge and practice gaps that may limit implementation of evidence-based recommendations for MR care. Specifically, half of primary care physicians reported uncertainty regarding timing of intervention for patients with severe primary or functional MR. Physicians in all groups reported that quantitative indices of MR severity were frequently not reported in clinical echocardiographic interpretations, and that these measurements were not consistently reviewed when provided in reports. In the treatment of MR, nearly 30% of primary care physician and general cardiologists did not know the volume of mitral valve repair surgeries by their reference cardiac surgeons and did not have a standard source to obtain this information. After review of the survey results, the expert panel summarized practice gaps into 4 thematic areas and offered proposals to address deficiencies and promote better alignment with the 2014 ACC/American Heart Association valvular disease guidelines. CONCLUSION Important knowledge and skill gaps exist that may impede optimal care of the patient with MR. Focused educational and practice interventions should be developed to reduce these gaps.
Collapse
Affiliation(s)
- Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Paul Grayburn
- Department of Medicine, Baylor Heart and Vascular Hospital and the Heart Hospital Baylor Plano, Houston, TX
| | - Jill A Foster
- Education Needs Assessment & Research, American College of Cardiology, Washington, DC
| | | | - Vinay Badhwar
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - James S Gammie
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Salvatore P Costa
- Department of Medicine, Dartmouth-Hitchcock Medical Center, New Lebanon, NH
| | | | - Michael J Rinaldi
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC
| | - Vinod H Thourani
- Department of Surgery, Emory University Medical Center, Atlanta, GA
| | - Randolph P Martin
- Valvular and Structural Heart Disease, Piedmont Healthcare, Atlanta, GA
| |
Collapse
|
38
|
Badhwar V, Smith AJ, Cavalcante JL. A pathoanatomic approach to the management of mitral regurgitation. Trends Cardiovasc Med 2016; 26:126-34. [DOI: 10.1016/j.tcm.2015.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
|
39
|
Lopez-Mattei JC, Ibrahim H, Shaikh KA, Little SH, Shah DJ, Maragiannis D, Zoghbi WA. Comparative Assessment of Mitral Regurgitation Severity by Transthoracic Echocardiography and Cardiac Magnetic Resonance Using an Integrative and Quantitative Approach. Am J Cardiol 2016; 117:264-70. [PMID: 26684513 DOI: 10.1016/j.amjcard.2015.10.045] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
Although transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) are validated in quantitation of mitral regurgitation (MR), discrepancies may occur. This study assesses the agreement between TTE and CMR in MR and evaluates characteristics and clinical outcome of patients with discrepancy. From our institutional database, 70 subjects with MR underwent both TTE and CMR within 30 days (median 3 days). MR was evaluated semiquantitatively (n = 70) using a 4-grade scale and quantitatively (n = 60) with calculation of regurgitant volume (RVol) and regurgitant fraction (RF). Of the 70 subjects, qualitative assessment by TTE yielded 30 subjects with mild MR, 17 moderate, and 23 moderately severe or severe MR. Exact concordance in MR grade was seen in 50% and increased to 91% when considering concordance within one grade of severity (κ = 0.44). A modest correlation was observed for RVol and RF between both methods (r = 0.59 and 0.54, respectively, p <0.0001). Ten patients had a significant discrepancy in quantitative MR (difference in RF >20%); the frequency of secondary MR was higher (100% vs 46%; p = 0.003) in patients with discrepancy. Although interobserver variability in RF was higher with TTE compared with CMR (-5.5 ± 15% vs 0.1 ± 7.3%), patients with discrepancy were equally distributed by severity and clinical outcome without an overestimation by either method. In conclusion, there is a modest agreement between TTE and CMR in assessing MR severity. In patients with discrepancy, there is a higher prevalence of functional MR, without a consistent overestimation of MR severity by either method.
Collapse
Affiliation(s)
- Juan C Lopez-Mattei
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - Homam Ibrahim
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - Kamran A Shaikh
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - Dimitrios Maragiannis
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas
| | - William A Zoghbi
- Houston Methodist DeBakey Heart and Vascular Center, Cardiovascular Imaging Center, Echocardiography and Cardiac Magnetic Resonance Laboratories, Houston, Texas.
| |
Collapse
|
40
|
Sargent J, Connolly DJ, Watts V, Mõtsküla P, Volk HA, Lamb CR, Luis Fuentes V. Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging. J Small Anim Pract 2015; 56:641-50. [DOI: 10.1111/jsap.12410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/29/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Sargent
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - D. J. Connolly
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Watts
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - P. Mõtsküla
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - H. A. Volk
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - C. R. Lamb
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Luis Fuentes
- The Royal Veterinary College; University of London; Herts AL9 7TA
| |
Collapse
|
41
|
A Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair. Anesth Analg 2015; 121:34-58. [DOI: 10.1213/ane.0000000000000726] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
42
|
Secondary Mitral Regurgitation in Heart Failure. J Am Coll Cardiol 2015; 65:1231-1248. [DOI: 10.1016/j.jacc.2015.02.009] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 12/23/2022]
|
43
|
Calkoen EE, Westenberg JJM, Kroft LJM, Blom NA, Hazekamp MG, Rijlaarsdam ME, Jongbloed MRM, de Roos A, Roest AAW. Characterization and quantification of dynamic eccentric regurgitation of the left atrioventricular valve after atrioventricular septal defect correction with 4D Flow cardiovascular magnetic resonance and retrospective valve tracking. J Cardiovasc Magn Reson 2015; 17:18. [PMID: 25827288 PMCID: PMC4332442 DOI: 10.1186/s12968-015-0122-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/22/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To characterize and directly quantify regurgitant jets of left atrioventricular valve (LAVV) in patients with corrected atrioventricular septal defect (AVSD) by four-dimensional (4D)Flow Cardiovascular Magnetic Resonance (CMR), streamline visualization and retrospective valve tracking. METHODS Medical ethical committee approval and informed consent from all patients or their parents were obtained. In 32 corrected AVSD patients (age 26 ± 12 years), echocardiography and whole-heart 4DFlow CMR were performed. Using streamline visualization on 2- and 4-chamber views, the angle between regurgitation and annulus was followed throughout systole. On through-plane velocity-encoded images reformatted perpendicular to the regurgitation jet the cross-sectional jet circularity index was assessed and regurgitant volume and fraction were calculated. Correlation and agreement between different techniques was performed with Pearson's r and Spearman's rho correlation and Bland-Altman analysis. RESULTS In 8 patients, multiple regurgitant jets over the LAVV were identified. Median variation in regurgitant jet angle within patients was 36°(IQR 18-64°) on the 2-chamber and 30°(IQR 20-40°) on the 4-chamber. Regurgitant jets had a circularity index of 0.61 ± 0.16. Quantification of the regurgitation volume was feasible with 4DFlow CMR with excellent correlation between LAVV effective forward flow and aortic flow (r = 0.97, p < 0.001) for internal validation and moderate correlation with planimetry derived regurgitant volume (r = 0.65, p < 0.001) and echocardiographic grading (rho = 0.51, p = 0.003). CONCLUSIONS 4DFlow CMR with streamline visualization revealed multiple, dynamic and eccentric regurgitant jets with non-circular cross-sectional shape in patients after AVSD correction. 4DFlow with retrospective valve tracking allows direct and accurate quantification of the regurgitation of these complex jets.
Collapse
Affiliation(s)
- Emmeline E Calkoen
- />Division of Paediatric Cardiology, Department of Paediatrics, Leiden, The Netherlands
- />Department of Anatomy and Embryology, Leiden, The Netherlands
| | | | | | - Nico A Blom
- />Division of Paediatric Cardiology, Department of Paediatrics, Leiden, The Netherlands
| | | | - Marry E Rijlaarsdam
- />Division of Paediatric Cardiology, Department of Paediatrics, Leiden, The Netherlands
| | - Monique RM Jongbloed
- />Department of Anatomy and Embryology, Leiden, The Netherlands
- />Department of Pediatric Cardiology, Leiden University Medical Center, J6 Albinusdreef 2, Leiden, ZA 2333 The Netherlands
| | | | - Arno AW Roest
- />Division of Paediatric Cardiology, Department of Paediatrics, Leiden, The Netherlands
| |
Collapse
|
44
|
Kusunose K, Cremer PC, Tsutsui RS, Grimm RA, Thomas JD, Griffin BP, Popović ZB. Regurgitant Volume Informs Rate of Progressive Cardiac Dysfunction in Asymptomatic Patients With Chronic Aortic or Mitral Regurgitation. JACC Cardiovasc Imaging 2015; 8:14-23. [DOI: 10.1016/j.jcmg.2014.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 11/25/2022]
|
45
|
Ng A, Swanevelder J. The third ultrasound dimension in anaesthesia and intensive care. Br J Anaesth 2014; 114:366-9. [PMID: 25315145 DOI: 10.1093/bja/aeu341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ng
- Heart and Lung Centre, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, West Midlands WV10 0QP, UK
| | - J Swanevelder
- Department of Anaesthesia, Groote Schuur and Red Cross War Memorial Children's Hospitals, University of Cape Town Medical School, Anzio Road, Observatory 7925 Cape Town, South Africa
| |
Collapse
|
46
|
Lancellotti P, Zamorano JL, Vannan MA. Imaging challenges in secondary mitral regurgitation: unsolved issues and perspectives. Circ Cardiovasc Imaging 2014; 7:735-46. [PMID: 25027455 DOI: 10.1161/circimaging.114.000992] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrizio Lancellotti
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.).
| | - Jose-Luis Zamorano
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.)
| | - Mani A Vannan
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.)
| |
Collapse
|
47
|
Real-Time Three-Dimensional Echocardiographic Flow Quantification in Valvular Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9298-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
48
|
Zamorano JL, Fernández-Golfín C, González-Gómez A. Quantification of mitral regurgitation by echocardiography. Heart 2014; 101:146-54. [PMID: 24780908 DOI: 10.1136/heartjnl-2012-303498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- José L Zamorano
- Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | |
Collapse
|
49
|
Wang W, Lin Q, Wu W, Jiang Y, Lan T, Wang H. Quantification of Mitral Regurgitation by General Imaging Three-Dimensional Quantification: Feasibility and Accuracy. J Am Soc Echocardiogr 2014; 27:268-76. [DOI: 10.1016/j.echo.2013.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Indexed: 11/25/2022]
|
50
|
Hsiao A, Tariq U, Alley MT, Lustig M, Vasanawala SS. Inlet and outlet valve flow and regurgitant volume may be directly and reliably quantified with accelerated, volumetric phase-contrast MRI. J Magn Reson Imaging 2014; 41:376-85. [PMID: 24677253 DOI: 10.1002/jmri.24578] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/28/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether it is feasible to use solely an accelerated 4D phase-contrast magnetic resonance imaging (4D-PC MRI) acquisition to quantify net and regurgitant flow volume through each of the cardiac valves. MATERIALS AND METHODS Accelerated, 4D-PC MRI examinations performed between March 2010 through June 2011 as part of routine MRI examinations for congenital, structural heart disease were retrospectively reviewed and analyzed using valve-tracking visualization and quantification algorithms developed in Java and OpenGL. Excluding patients with transposition or single ventricle physiology, a total of 34 consecutive pediatric patients (19 male, 15 female; mean age 6.9 years; age range 10 months to 15 years) were identified. 4D-PC flow measurements were compared at each valve and against routine measurements from conventional cardiac MRI using Bland-Altman and Pearson correlation analysis. RESULTS Inlet and outlet valve net flow were highly correlated between all valves (P = 0.940-0.985). The sum of forward flow at the outlet valve and regurgitant flow at the inlet valve were consistent with volumetric displacements in each ventricle (P = 0.939-0.948). These were also highly consistent with conventional planar MRI measurements with net flow (P = 0.923-0.935) and regurgitant fractions (P = 0.917-0.972) at the outlet valve and ventricular volumes (P = 0.925-0.965). CONCLUSION It is possible to obtain consistent measurements of net and regurgitant blood flow across the inlet and outlet valves relying solely on accelerated 4D-PC. This may facilitate more efficient clinical quantification of valvular regurgitation.
Collapse
Affiliation(s)
- Albert Hsiao
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | | | | | | |
Collapse
|